Side effects and patient tolerance with the use of blood flow restriction training after ACL reconstruction in adolescents: a pilot study

Review written by Dr Nicholas Rolnick info

Key Points

  1. For the first time in research, low-load training (20-30% 1RM) with blood flow restriction (BFR) closely following ACL reconstruction was shown to be safe and well tolerated in a cohort of adolescents over 12 weeks.
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The use of blood flow restriction (BFR) following surgery is indicated to assist in attenuating the loss of muscle mass that is frequently observed in the early post-operative period (1). However, during the first six weeks following surgery, risk of acquiring a blood clot (likely the most well-known contraindication to BFR) is at its highest (2). Therefore, as the evidence on safety is growing but still limited, integrating BFR training has been only recommended following the referring surgeon’s endorsement despite the timeline of when the patient had surgery (3).

In addition, a common question in clinical practice is if there is an appropriate age for the integration of BFR into a post-surgical plan of care and whether younger patients can safely use BFR training following surgery. Before the publication of this paper, little was known about the post-surgical safety of BFR in adolescents.

This pilot study investigated and recorded potential side effects and patient tolerance to BFR training following ACL reconstruction in young adolescents.

The use of blood flow restriction following surgery can assist in attenuating the loss of muscle mass that occurs in the early post-operative period.
This study found that blood flow restriction training can be safely applied in adolescents approximately 8 days after ACL reconstruction.


This study investigated the effects of low-load BFR (20-30% 1RM when appropriate) on safety in adolescents (between 12-18 years old) following ACL reconstruction using a quadriceps tendon autograft. BFR was applied using the Delfi Personalized Tourniquet System (11.5 cm width)

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